Healthcare Provider Details

I. General information

NPI: 1104720572
Provider Name (Legal Business Name): PATHWAY CLINICAL GROUP, A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 RIO SAN DIEGO DR
SAN DIEGO CA
92108-1634
US

IV. Provider business mailing address

8880 RIO SAN DIEGO DR
SAN DIEGO CA
92108-1634
US

V. Phone/Fax

Practice location:
  • Phone: 619-485-5678
  • Fax: 619-789-1235
Mailing address:
  • Phone: 619-485-5678
  • Fax: 619-789-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANDON ANDREW LOZANO
Title or Position: OWNER
Credential:
Phone: 619-485-5678